Annals of emergency medicine
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We present the case of a patient with traumatic ventricular septal defects following blunt chest trauma. The pathophysiology and clinical presentation of the lesion are discussed. Definitive diagnostic procedures should be performed immediately in patients with suggestive findings to establish the diagnosis and to determine the magnitude of the shunt and the presence of pulmonary hypertension.
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Adherence to physician-developed process criteria is critical to the medical and legal acceptance of algorithm-directed nonphysician care of acute non-life-threatening illnesses seen in the emergency department. It is generally assumed that adherence to prescribed medical process criteria results in acceptable patient outcomes. ⋯ Our evaluation indicated that, under ideal circumstances of daily audit and supervisory feedback, a conformance rate of 80% was achieved. This is a 100% improvement over a group in which neither element was operative.
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A 31-year-old white man with a core temperature of 60.8 F (16 C) and ventricular fibrillation was successfullly resuscitated using active core and external rewarming techniques. Rectal temperature at the time of reestablished electromechanical cardiac activity was 68 F (20 C), a temperature previously thought to be incompatible with successful resuscitation from venticular fibrillation. We are not aware of previous case reports describing survival following a lower documented core temperature.
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A research project was developed to study the process of professional socialization in graduate medical education by describing and analyzing the development of emergency medicine residencies in comparison to those of surgery and internal medicine. Based on the assumption that residency programs have a profound impact on the quality, distribution, and career patterns of physicians, researchers surveyed residents and residency directors in the three specialty groups to determine the following: characteristics of founders of the programs, factors influencing physicians to enter a specialty, variations in residency program organization and structure, and career patterns of physicians entering the specialty. Implications are drawn from the data and applied to the development of residency training. Anwar RAH: Trends in training: focus on emergency medicine.